Background: Holter monitoring is routinely used in patients referred for the evaluation of syncope, but its diagnostic value in different patient groups is unclear, as is its impact on device implantation(pacemaker or cardioverter-defibrillator).
Aim: To determine the diagnostic yield of Holter monitoring in the routine evaluation of syncope, and its impact on subsequent device implantation.
Methods: We reviewed all Holter studies in patients referred with syncope between JAN. 2013 to DEC. 2013. Strict criteria were applied to determine whether a study was diagnostic. The diagnostic value ofHolter monitoring (overall and in five subgroups: age, gender, structural heart disease, ejection fraction, medication) and its impact on the implantation of devices, were determined.
Results: Of the 104 Holter studies, 86 (82.6%) were classified as completely normal. Eleven (10.5%) were classified as abnormal, but unlikely to explain syncope due to non-sustained ventricular tachycardia.Inpatients with syncope,7(6.7%) were considered to explain the syncope. Structural heart disease, ejection fraction and age and sex were significant predictors of a diagnostic study(all p < 0.01). A device was implanted in 3 patients (2.8%) whose initial Holter explain their Syncope.
Conclusion: The overall diagnostic yield of Holter monitoring in the evaluation of syncope was 6.7%, with dramatic differences between subgroups. Our data suggest that the impact of Holter monitoring on device implantation is generally overestimated.